Uterine rupture, perioperative and perinatal morbidity after single-layer and double-layer closure at cesarean delivery

Technical aspects of the cesarean section

“…Other studies did not confirm this risk, but showed a higher frequency of asymptomatic uterine dehiscence. According to this, there is not enough evidence for the routine use of a single-layer closure compared with double-layer closure [17]. Further investigations are needed to analyze which factors can affect the strength of the closure.…”

Impact single versus double layer uterine closure in caesarean section to uterine rupture

“…Double layer uterine closure was defined an addition of continuous suture over the first layer. 9 However, Cynthia G et al stated that single-layer uterine closure raised the risk of uterine rupture significantly (p=0.004; OR 8.01; 95% CI 1.96-32.79). 8 Similar to this study, Emmanuel B et al stated that uterine rupture was related to single layer closure with an adjusted OR 2.69 and 95% CI 1.37-5.28 (p<0.05).…”

“…In this EBCR, we included 4 articles, consisting of 1 systematic review articles and 3 research articles. We did the critical appraisal steps for 4 articles written by Roberge S et al, Gyamfi C et al, and Durnwald C et al, and Emmanuel B et al [7][8][9][10] Figure 1 showed the flowchart of selecting articles using in the EBCR. …”

“…This systematic result was appropriate to study by Celeste D et al which concluded that in single layer uterine closure procedure; there was no increased risk of uterine rupture during a trial of labor. 9 In this study, single layer closure was defined as one continuous suture applied to lower uterine segment with additional interrupted haemostatic sutures placed as needed. Double layer uterine closure was defined an addition of continuous suture over the first layer.…”

“…6 There have been only 1 systematic review and 3 studies conducted to know the impact of single versus double layer uterine closure to uterine rupture. [7][8][9][10] However, there is still no formal publication about evidence-based case report (EBCR) discussing about this topic. Therefore, we do this analysis to solve the question which often arises during our practice.…”